Healthcare Provider Details

I. General information

NPI: 1427498559
Provider Name (Legal Business Name): VASILE F CORPODEAN RSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W HIGHWAY 22
BARRINGTON IL
60010-1919
US

IV. Provider business mailing address

445 S CLEVELAND AVE APT 201
ARLINGTON HEIGHTS IL
60005-2161
US

V. Phone/Fax

Practice location:
  • Phone: 847-842-4356
  • Fax:
Mailing address:
  • Phone: 847-436-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: